TalkingaboutsexandCOPD

Theory,research,andimplicationsforpractice

DrWilliamLevackPhDUniversityofOtagoWellington

Levack WMM(2014).Sexualwellbeingforpeoplewithchronicobstructivepulmonarydisease:Relevanceandrolesforphysiotherapy.NewZealandJournalofPhysiotherapy,42(2),170-176.

LevackWMM,PootB,Weatherall M,&Travers J.(2015).Interventionsforsexualdysfunctioninpeoplewithchronicobstructivepulmonarydisease(COPD).CochraneDatabaseofSystematicReviews,Issue9,Art.No:CD011442.

Whysex?

Becauseolderpeoplelikesextoo…• USsurvey(2004)of3000+adults57-85years:– 75-85years:39%ofmen&17%ofwomensexuallyactivewithpartnerinpreviousyear.

– 54%ofsexuallyactive75-85yolds,havingsex2-3timesamonth(Lindauetal.,2007)

Forpeopleonventilatorsathome

Basedonastudyof333peoplewithresp.failure(age:mean63.3;SD9.3yrs;Germany)• 34%sexuallyactive(20%over70yrs)• Sexuallyactivepeopleyounger,betterlungfunction,withpartner

• 36%reportedâ sexaftergoingonventilator;but13%reportedá sex

(Schonhofer etal2001)

Healthandsex

• Poorerhealthstatusnegativelyinfluencessexualactivityandsexualsatisfaction

(Lindauetal2007,Matthiasetal1997)

• Guidelines&systematicreviewsexexistforanumberofconditions,e.g.– Cardiovasculardisease(e.g.Steinkeetal2013)– Diabetes(e.g.Pontiroli etal2013,Vardi andNini 2007)– Cancer(e.g.Milesetal2007)

…butnotsomuchforCOPD

Someassumptions

Inadditiontoheterosexualandsame-sexcouples,considerationsshouldalsobegivento:• Transgenderpeople• Peoplewhoaresingle• Peoplewhoareasexual/uninterestedinsex

PrevalenceofsexualdysfunctioninpeoplewithCOPD

• Erectiledysfunction:– 70-85%ofmenw.COPD(Collinsetal2012,Kahraman etal2013,Karadag etal2007,

Köseoğlu etal2005,Lauretti etal2016)

– 56%ofage-matchedcontrols(Kahraman etal2013)

– COPDanindependentpredictorofED(Kahraman etal2013)

• AlsoevidenceofCOPDassoc.with:– Reducedsexualdesire,lowerfrequencyofsex,inabilitytoachieveorgasm,difficultyfindingsexpleasurable.(Kaptein etal2008,Collinsetal2012)

Reasonsforsexproblems:COPD

• Hormonal• Physiological• Psychological• Sociological• Pharmaceutical

Reasonsforsexproblems:COPD

• Hormonal–MenwithCOPDhave3.21nmol/L(95%CI1.23to5.18nmol/L)lesstotaltestosteronethanage-matchedmenwithoutCOPD(Atlantisetal2013).

Reasonsforsexproblems:COPD

• Physiological– Notenoughpuff– Exercisedeconditioning– BodypositionandV/Qmatching

QUESTION:Whatdegreeofexercisecapacityisrequiredforsexualintercourse?

RecommendationforpeopleatriskofMI:• Ifyoucantolerate3-5METswithoutcardiacsymptom;sexshouldbesafe(Steinkeetal2013).…i.e.a‘brisk’walk(5-6.5kph).Ortwoflightofstairs.

Note:1MET=3.5mlO2/kg/min(approx.amountofoxygennormallyconsumedatrest)

QUESTION:• Whatisthebasisforthe3-5METfigureforsex?

METSandsex

Origin:Bohlenetal.1984

DetailsofBohlenetal.1984

• 10health,youngcouples• Valuesrelatetothemalepartneronly

Activity AverageMETS 95%CI

Foreplay 1.4METs 1.2-1.6METs

Orgasm:Fem. stim.male 1.7METs 1.3-2.1 METs

Orgasm: Malestim.Self 1.8METs 1.5-2.1METs

Orgasm: Fem.ontop 2.5METs 1.8-3.1 METs

Orgasm:Maleontop 3.3METs 2.6-4.1METs

So…

• 3-5METsisa‘safetylimit’recommendation• Lotsofpleasurablesexualactivitiesrequirelessenergyexpenditure.

• Sexualactivityshouldbeequatedto:“arelaxedwalkforafewblocks,interspacedbyascendingoneortwoflightsofstairsatmoderateand,mostimportantly,ataverymuchindividualpace’(Araujo,2009,p.1034).

PositioningandV/Qmatching

• COPDàSubtle,idiosyncraticchangesinV/Qmatching

àInconsistentthroughoutlung

Positionsforefficientbreathing

Hough(1996)

PositioningforsexwithCOPD

Likelyneedstobeindividualised,but…Probablybad…• 100%supine• Effortfulpositions(holdingweightonupperlimbs)• Weightonchest• Coveringmouth

PositioningforsexwithCOPD

Likelyneedstobeindividualised,but…Probablygood…• Pillowsforsupport• Chestclearance&inhalersbeforehand• Relaxation• Upperrightchestpositions• Supplementaloxygen• ‘Toys’toreduceeffort

Positionforsex

(Levack,2014)

Otherfactors

• Psychologicalfactors• Sociologicalfactors• Pharmaceuticalfactors

PLISSITModel

P:PermissionLI:LimitedinformationSS:SpecificsuggestionsIT:Intensivetherapy

Conclusion

• Apleasurable,satisfyingsexlifeisimportantformanypeopleregardlessofageorseverityofCOPD

• Sexualitycanbeaffectedbymanyfactors• HealthprofessionalscanhavearoleinthemanagementofproblemswithsexualfunctioninCOPD.

• Readuponit,discussinclinicalsupervision,andbeconfidentthatitisimportant!J